Recommended Practices: Interventions

Overview

In the past, classic interventions were viewed as a principle means of facilitating a
chemically dependent pilot’s entrance into treatment. However, over the years the
role of classic interventions has dramatically decreased, while other intervention
types have gained prominence. For a detailed discussion of these types and other
factors pertinent to interventions, please refer to the “Interventions” section under
the “Disease Info” menu of this website. In this examination of recommended
practices, we’ll expand upon the view of interventions as a coordinated event,
consider the roles of various parties in those intervening circumstances, and look at
some of the obstacles that interfere with the process.

One should recall that a classic intervention is an event that presents reality
(specific information) in a receivable form (with concern) to a person unable to
see that reality (in denial). We will expand this definition beyond the view of an
intervention as an event, to an intervention as a process or series of events. But,
first, we’ll discuss how the environment has changed and why classic interventions
have become very rare.

History

Over the years there have been many advances in the science used to evaluate the
disease of chemical dependency. Prior to these advancements, the behavior or
physical consequences associated with the illness were often quite pronounced
before a diagnosis was made. At the chronic stage of the disease one might clearly
observe cognitive impairment or the manifestation of physical symptoms such as
jaundice or other changes in a person’s appearance. These facts were clear and
easily established, and the relatively small community associated with commercial
aviation 40 years ago made such information common knowledge. At that time,
though, it was socially more acceptable to drink regularly, and it usually required a
significant level of misconduct for others to “intervene” in the affairs of the affected
person. Also, medical understanding of the illness was much less developed, as
was the effectiveness of the various treatment options available to deal with the
problem. All of these factors supported an environment of “late” identification.
And, more often than not, if the diagnosis wasn’t made from the presence of an
undeniable symptom, such as alcohol-induced cirrhosis, the assessment process was
initiated through the use of a classic, formal intervention.

In present times, alcohol misuse and abuse is less tolerated than in the past. One
need only examine the changes in DUI laws to verify this change in attitude. There
have also been dramatic improvements in medical understanding of addictive
disease and in the means to test for its presence. There has been increased
education about the disease (in part due to HIMS) and a dramatic expansion of
work place drug and alcohol testing. Additionally, unlike many other medical
conditions, FAA regulations specify the criteria used to diagnosis chemical abuse
and dependency in the pilot population. FAA has also expanded the sources of
information it uses to evaluate chemical dependency illness to include such things
as the National Drivers Record.

All of these changes have resulted in greater awareness of the disease and a desire
to identify those who are afflicted as early as possible. However, by definition,
disease in the earlier stages is less clearly manifest than later, and the basis to
conduct a classic intervention weaker. Without a significant preponderance of
evidence, it is more likely a means will be chosen to persuade the affected individual
to seek help rather than to try to compel them to do so through the use of a classic
intervention. One should also note the outcome of a classic intervention is not
guaranteed, and a subject may refuse to get help. Hence the expansion of other
non-classical means of intervening on a person suspected of having chemical
dependency disease.

Current Environment

People who suffer from chemical dependency illness demonstrate some common
characteristics that create barriers to identification. The “party” behavior that
frequently accompanies misuse often leads to shame and regret for the dependent
individual. These emotions will make it very likely the person will engage in
rationalization and/or denial surrounding these events and behaviors. Of course,
the mood-altering nature of the chemicals also skews self-awareness and recall.
As these psychological effects and defense mechanisms operate, information is
altered and compartmentalized. So, it is often very difficult to obtain an accurate
and complete picture of events from the afflicted individual. Being aware of this
process should create an expectation for those hearing about such events that they
are not hearing the “whole story.” In fact, providing only portions of “the truth” is a
very common aspect of the manifestation of denial. It becomes necessary, therefore,
to put the pieces of the “puzzle” together to get a clear understanding of what is
actually taking place.

Companies and unions, by their very nature, tend to have different pieces of the
available information. For example, a union volunteer may have a report from a
concerned co-worker while the company may have information related to training
problems or sick leave usage. In order to determine the probability that chemical
dependency illness may be a common underlying cause for these issues, it is very
important to be aware of all the available information. On most properties the
union is uncomfortable with company access to information that was presented to
union representatives, and vice versa. But, it is a necessary requirement for some
person to be given the opportunity to assess the information held by both parties.
This individual also needs to be versed in the symptoms of chemical dependency
disease and be able to make a balanced judgment about whether the weight of
the evidence is sufficient to take action. Additionally, the person must, of course,
be willing to maintain a high level of confidentiality about their investigation and
it’s conclusions. In most cases, this task will fall to a member of the company’s
Employee Assistance Program, a contracted addiction specialist, or to a member of
the union’s HIMS committee.

If the investigation determines a high probability of chemical dependency as a
source for the observed behaviors, one must then determine if an assessment is
practical. In some cases a company can compel an employee to undergo a medical
evaluation. In such cases, it is wise to include a chemical dependency evaluation
as part of that process. In other cases, the company will not be able to direct an
assessment. In those cases, one may be able to encourage the pilot to volunteer for
the evaluation if punitive actions, which are commonly being contemplated, are held
in abeyance. In all cases, the goal for the company and the union is to determine if
the employee is suffering from an illness. That determination is accomplished by
obtaining a substance abuse assessment, not by achieving some particular outcome.
Qualified medical professionals should make the diagnosis of the illness.

Types

As previously described the use of classic interventions has decreased. For those
unfamiliar with that term, a classic intervention is commonly led by a trained
interventionist, includes family members, requires many hours to prepare,
and is normally highly emotionally charged. Today, this type of intervention is
almost exclusively conducted off company property and rarely includes the direct
involvement of company supervisors. Union representative may be in attendance,
but are normally there for peer support and to assure the subject that his or her job
is safe and that there are benefits available.

When there is strong evidence of a problem, and some significant possibility the
behavior may be related to chemical dependency, most companies today will try to
meet the legal basis needed to conduct a medical evaluation. This basis is normally
expressed in the Pilot Working Agreement or Contract. One should note that
chemical dependency disease is rarely clearly evident but may instead be expressed
as spousal or child abuse, an argumentative attitude, lying, evasiveness, irregular
performance, volatile personality, being accident prone, tardiness, absenteeism,
etc. Of course, sometimes these behaviors are not related to chemical dependency
disease, but it often takes someone looking beyond the obvious facts to establish
it’s presence or not. We therefore recommend that company directed medical
evaluations include an assessment for chemical abuse or dependency.

If the evidence of a problem is not sufficient for a classic intervention or a company
directed medical evaluation, the next level of intervention is usually a peer
intervention. As the title suggests, peer interventions are conducted without
the direct participation of the company. Practically speaking, there are peer
interventions that are conducted without company knowledge, and those conducted
with company support. In our view, those conducted with company support, i.e. on
company property after the pilot has spoken with supervisors about the associated
circumstances, are generally more successful. Usually this success is not due to
what is said by the participants, but can be attributed to the subject being more
willing. Cooperation between the union and company, no matter how limited,
increases the perceived cost of being uncooperative.

Another type of peer intervention would be one-to-one contact between a HIMS
committee member and the individual. These types of contacts are almost never
sufficient in themselves to get the person to agree to an assessment, unless the
affected pilot initiated the contact. In those cases, the pilot may agree to an
assessment. Otherwise, the typical response is denial of the problem and resistance
to further inquiry.

Finally, an intervention may be the result of direct FAA action. In this case, the FAA
becomes aware of questionable behavior either because the airman reported it
when taking his/her physical, or because it was discovered when checking the data
in the National Drivers Record. Disclosure of multiple DUI’s or DUI’s with a high
level Blood Alcohol Content (BAC) will commonly result in direction from FAA to
be assessed for chemical dependency disease. One doesn’t normally think of these
directed assessments as interventions at all, but practically speaking, they achieve
the same result.

Management / Union Role

Managers are rarely comfortable when dealing with the issues of chemical
dependency. Most lack training or background with the problem. By its nature,
chemical dependency is a personal problem that is often expressed in behavior that
wouldn’t even be examined under other medical circumstances. So, discomfort is
understandable. In most cases, a manager can ably fill the role of a concerned and
supportive supervisor, while maintaining good boundaries with the affected pilot.
Sometimes, though, being supportive may lead a supervisor to agree to actions that
are not in the assessment’s best interest such as allowing the pilot to “go home for
just a day or two” prior to the evaluation. Such inappropriate decisions can usually
be avoided if the supervisor consults with a member of the HIMS committee before
making any decisions related to the affected individual. Chemically dependent
people are masters of delay and obfuscation. It is best not to give them any
additional time to rationalize their behavior or to create support for their “story.”

Union members on the HIMS committee are often more comfortable dealing
with chemically dependent individuals. They understand the disease and the
behavior. However, HIMS committee members might get confused about their
role. Sometimes committee members try to take on the responsibilities of a pilot
representative or contract administrator, or even a Chief Pilot. They also might
confuse their function with those who act as a pilot’s AA or NA sponsor, particularly
as it relates to a promise of anonymity or privacy. While anonymity and privacy
are critical to some aspects of recovery and the functioning of HIMS, it must be
appropriate. If the maintenance of anonymity or privacy acts to prevent or delay
getting proper medical treatment to an individual who is known to be or is likely to
be chemically dependent, such a position may not be in the person’s best interests.
The disease state is enhanced and compounded by secrets, lies, deception, and poor
communication.

Constraints

Varying factors can act as a constraint against conducting an intervention. The
first such factor is compartmentalization and timeliness of information. Over time,
chemically dependent individuals will have multiple instances of inappropriate
behavior. But, this behavior may not be apparent because of barriers to awareness.
Turnover of supervisors is often high leading to little corporate memory of past
events. Also, supervisors don’t normally share information about employee
problems with HIMS committee volunteers. Similarly, committee volunteers may
be reticent to share reports with company supervisors. Known events may occur
years apart and not result in associating them as possible evidence of chemical
dependency. And, union policy may discourage the collection of information
related to potential pilot problems or concerns. In short, any attempt to take a long-
term, well informed perspective of all available information is difficult. But, such
a perspective is as essential as it is difficult, so we recommend diligent efforts to
establish this long-term knowledge.

The language in various statutes and in the Pilot Working Agreement also may
act as a constraint to taking action. In these cases, it is important to recognize
the appropriate function served by this language. The company has interests
that must be protected and risks that must be managed, but these interests and
efforts must be kept in balance with the rights and interests of the individual.
Our recommendation is to respect these legal constraints and to be patient. It
is never good when one union committee function is working at cross-purposes
with another. And, if sufficient cause for an intervention is not well established,
an intervention and assessment’s outcome is likely to be uncertain. One may
rest assured if an individual is chemically dependent, more evidence will become
available over time. So, an intervention will still be an option at that later date.

Personal relationships with the affected pilot may also act as a constraint to
performing an intervention. If the supervisor and the pilot have a positive history
with each other, the supervisor may be less likely to compel an assessment. Those
subject to interventions generally perceive them as “negative” events, so an “old
friend” might choose to give the subject an “out.” We do not recommend such acts
of generosity as they typically delay getting help to someone who may suffer from
a chronic, fatal disease. If the supervisor, instead, has negative past experience
with the affected pilot, the supervisor may be less inclined to afford access to an
assessment and treatment. The supervisor may feel that entrance into HIMS is
letting the pilot “off the hook” for past misbehavior. The reality is the pilot’s past
misbehavior leads to an extensive rehabilitation program. HIMS requires thousands
of hours of participation in self-help groups and formal therapy, extensive medical
evaluations, and abstinence for the remainder of one’s flying career. These are
not small concessions. In the end, an affected pilot who is successful in recovery
will often exhibit loyalty, dependability, and gratitude far above those present in
an average employee. They will, in fact, become a joy to know and with whom to
work. We urge all involved to remember that those being intervened upon are sick.
They need your compassion and support, not condemnation for exhibiting behavior
related to their illness.